Chiquita Brooks-LaSure is the first Black woman to lead the Centers for Medicare and Medicaid Services (CMS), a $1 trillion agency responsible for health care for more than 100 million people nationwide. Today’s 55-to-44 Senate confirmation vote tasks Brooks-LaSure with the Biden administration’s goal of increasing health coverage, equity, and access, all of which she has championed throughout her career. SELF spoke with health policy advocates about how Brooks-LaSure will likely approach key issues as CMS administrator.
On health coverage:
Medicaid and the Children’s Health Insurance Program (CHIP) are federal public health insurance programs that CMS administers in partnership with the states to cover people primarily with low incomes. CMS also oversees Medicare, the nation’s public insurance program for seniors, and the Affordable Care Act’s Health Insurance Marketplace—the exchange through which people can buy an Obamacare plan.
Brooks-LaSure will lead some of the same programs she helped to build. She worked behind the scenes to help congressional Democrats pass the Affordable Care Act in 2010 and later implemented the law at CMS and its umbrella agency, the U.S. Department of Health and Human Services (HHS). She left the Obama administration for the private sector in 2014.
But Brooks-LaSure returned to Capitol Hill for a 2019 hearing about how to achieve universal health coverage. Her testimony addressed the paradox of the Medicaid coverage gap: Despite living in poverty, more than 2 million people technically make too much money to qualify for Medicaid in red states that still refuse to expand eligibility under the Affordable Care Act. And those people make too little money to qualify for federal subsidies that could put Obamacare plans within reach.
Democrats campaigned their way to their control of Congress and the White House in no small part through promises to protect and expand health coverage. But they don’t always agree on the best way to provide insurance to more or all of the country. At the same 2019 congressional hearing, Brooks-LaSure outlined proposals to add public health insurance programs on top of private coverage often obtained through employers. However, she did not indicate her position on “single-payer” health care that would replace the web of private insurance plans with one government-run plan, à la “Medicare for all.”
Brooks-LaSure’s new role reunites her with HHS secretary Xavier Becerra, one of her former congressional collaborators on Obamacare and a longtime single-payer proponent. Their working relationship is expected to break with the past four years of Trump-era intradepartmental feuding. Both officials will ultimately take their orders from President Biden, who campaigned on a “public option” that would allow people to buy into plans modeled on Medicare while keeping private insurance intact.
“President Biden has made it very clear that his goals for improving the American health care system begin with building on the successes of the Affordable Care Act, and I am committed to working toward that goal,” Brooks-LaSure wrote in response to follow-up questions from Republican senator Chuck Grassley, who asked about her support for single-payer health care after her confirmation hearing in April.
On reproductive health care:
As the top CMS official, Brooks-LaSure will serve as a referee in the long-running feud over “defunding” Planned Parenthood. Various Republican-led state and national efforts to punish Planned Parenthood for offering abortion care inevitably punish people whose incomes limit their options for reproductive health care. Some red states want to remove Planned Parenthood from the list of approved Medicaid providers, despite the fact that Medicaid generally doesn’t cover abortion due to inherently discriminatory policies. The result is that contraception, breast and cervical cancer screenings, pregnancy tests, prenatal care, and more would also become inaccessible.
Through CMS, the Obama administration issued a stern reminder that by law, people can use Medicaid to access the provider of their choice. But in the Trump era, the agency rescinded this “free choice of provider” guidance and replaced it with its own tacit encouragement for GOP state officials to carry on their war against Planned Parenthood. In March a federal appeals court allowed Texas to kick Planned Parenthood out of Medicaid, stranding some 8,000 patients.
Brooks-LaSure now “will have the power to reaffirm vital legal protections, including the Medicaid Act’s free choice of provider provisions, that ensure access to reproductive and sexual health services in Medicaid, CHIP, and the ACA marketplaces,” Madeline Morcelle, a staff attorney for the National Health Law Program, tells SELF.
On maternal health:
Brooks-LaSure inherits a Medicaid program that covers more than 4 in 10 births nationwide, according to the latest Centers for Disease Control and Prevention data. The proportion is higher in some states.
The most recent COVID-19 relief package permits states to expand Medicaid coverage to 12 months postpartum. Until now, pregnant people with low incomes could only count on 60 days. “This leaves many, especially Black, Indigenous, and other people of color, vulnerable to the 12% of pregnancy-related deaths that occur after six weeks postpartum,” Morcelle says. “With lives on the line, we hope that the next CMS administrator will prioritize swiftly approving state proposals to take Congress up on the new option to extend coverage.”
The U.S. maternal mortality crisis kills Black women across all income and education levels at more than triple the rate of white women. Black women insured through Medicaid are particularly vulnerable to poor pregnancy outcomes, Brooks-LaSure and her former private-sector colleagues noted in a joint presentation from 2020. They proposed expanding Medicaid coverage of doula care, widely regarded to help address those racial disparities, in part by facilitating communication between patients and providers. “Some of the problems with maternal health care is that doctors and health care professionals don’t always listen to Black women when they talk about what’s going on with their bodies when they’re pregnant,” Marcela Howell, president and CEO of In Our Own Voice: National Black Women’s Reproductive Justice Agenda, tells SELF.
On health equity:
To Brooks-LaSure, health equity isn’t created in a vacuum, and the disparities are stark. Black, Hispanic, and American Indian/Alaska Native people each comprise roughly 30% of Medicaid beneficiaries and are significantly underrepresented in Medicare, which is overwhelmingly white, according to Kaiser Family Foundation data for each program.
Policy makers should work with “community voices,” Brooks-LaSure and her former private-sector colleagues emphasized in another health presentation. Brooks-LaSure’s approach aligns with the Black-woman-created reproductive justice framework that values the right to have or not have children as much as to parent them in safe, healthy, and sustainable communities. “We see her as an ally in making sure that health equity is a lens that she looks through in looking at Medicaid and Medicare priorities for communities of color,” Howell says.
Brooks-LaSure is poised to make an even bigger impact through the Biden administration’s White House Gender Policy Council, which works across federal agencies. “She will have a voice in talking about what kind of things she believes would be beneficial [beyond CMS],” Howell says.
Aryana Khalid, a chief of staff for CMS under the Obama administration, tells SELF that Brooks-LaSure is the right pick for real change. “At a time when we are finally seeing racial disparities and health inequities coming into mainstream consciousness,” Khalid says, “it is heartening to see a bold commitment to addressing these issues by nominating an exceptionally qualified woman of color.”
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